Monday, May 6, 2013

The Impact of Probiotics on Diverticulitis

Now that we are starting a new year, I want to share some relatively new information regarding another benefit of taking probiotics: the potential impact of probiotics on diverticulitis.

Recently, there have been studies evaluating probiotics as a therapy for diverticular disease of the colon.

First, a little background information; Diverticular disease is a western world disorder of the colon or large intestines. Diverticula are the outpocketing of the colon lining that protrude through the muscle wall of the colon. These developments are often the result of a diet low in fiber.

Why fiber? Fiber absorbs water, helping to make our stools larger and softer. Our western diet, lacking enough fiber, leads to smaller stools. As the colon contracts to release these stools, pressure increases on the colon wall. This increase in pressure can lead directly to the development of outpockets or sacs, prevalent primarily in the lower half of the colon (1).

As we age, the development diverticula is very common. Studies have found that by the age of 70, upwards of 60% of the population have diverticula or diverticulosis of the colon. This development generally begins after the age of 30 or 40 (1,2).

Most people who have diverticulosis have no symptoms and are not aware they have this condition. Usually the diverticula are found during a colonoscopic exam or a barium enema x-ray.

There are, however, approximately 20% of individuals with diverticulosis who will experience an inflammatory complication called diverticulitis. This is a bacterial infection involving one or more diverticula (2).

For years it was thought that an infection occurred in a diverticulum when a plug of stool or a food particle lodged in the diverticulum. The result was inflammation of the pocket lining and an infection or an abscess developed, eventually rupturing to create a localized perforation of the colon.

Fever and pain in the lower, left abdomen can be symptomatic of acute diverticulitis. Today, a CT scan of the abdomen can usually confirm a diagnosis of diverticulitis (1,2).

Treatment of diverticulitis is dependent upon the severity of the episode. Patients are typically started on antibiotics and prescribed a restricted diet. Sometimes patients require hospitalization, IV fluids and antibiotics. In severe cases surgery may be performed.

Once an episode resolves, patients are instructed to increase the fiber in their diets and, in the past, were advised to avoid seeds, nuts and particulate foods like popcorn. Recent studies have disproved the theory that seeds can precipitate an episode of diverticulitis (3).

The new notion is with regard to the associated inflammation of the lining (colonic mucosa) that surrounds a colonic pouch or diverticulum. Colonoscopic exams have revealed this inflamed lining and biopsies disclose findings of microscopic colitis. It is believed that this low grade inflammation can progress to acute diverticulitis.

It has been proposed that the microscopic colitis around a diverticulum is due to a change in the intestinal bacteria or microflora. The alteration in the microflora results in a chronic inflammation that can lead to diverticulitis (4).

There have been several trials that have studied the benefits of adding probiotics to individuals who have had diverticulitis. The results have shown that probiotics seem to lessen recurrent episodes (4,5,6).

Further studies are being conducted to evaluate the long-term benefits of probiotics for individuals who have recurrent diverticulitis. In the meantime, it seems reasonable to add a good probiotic, such as EndoMune, to a daily regimen of a high-fiber diet to prevent diverticulitis.

1) Diverticulitis: new frontiers for an old country: risk factors and pathogenesis.Korzenik JR; NDSG.J Clin Gastroenterol. 2008 Nov-Dec;42(10):1128-9.
2) Diverticular disease and diverticulitis.Sheth AA, Longo W, Floch MH.Am J Gastroenterol. 2008 Jun;103(6):1550-6. Epub 2008 May 13. Review.
3) Nut, corn, and popcorn consumption and the incidence of diverticular disease.Strate LL, Liu YL, Syngal S, Aldoori WH, Giovannucci EL.JAMA. 2008 Aug 27;300(8):907-14.
4) Probiotics and their use in diverticulitis.White JA.J Clin Gastroenterol. 2006 Aug;40 Suppl 3:S160-2. Review.
5) The effect of non-pathogenic Escheriachia coli in symptomatic uncomplicated diverticular disease of the colon. Rric P, Zavoral M. Eur J Gastroenterol Hepatol. 2003;15:313-315
6) Mesalazine and/or Lactobacillus casei in maintaining long-term remission of symptomatic uncomplicated diverticular disease of the colon.Tursi A, Brandimarte G, Giorgetti GM, Elisei W.Hepatogastroenterology. 2008 May-Jun;55(84):916-20.

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